Electronic Thesis and Dissertation Repository

Thesis Format



Master of Clinical Science


Family Medicine


Freeman, Thomas R.

2nd Supervisor

Terry, Amanda



There is a growing trend among family physicians (FPs) to focus their practice in specialized areas. The reasons underlying this trend are incompletely understood. A mixed methods study was conducted to understand this issue. A secondary analysis of data from a survey of Western University family medicine program graduates highlighted the associations of postgraduate third-year (PGY3) training and physician’s remuneration strategy with focused practice. The overall service provision of focused practice FPs was centered on specialized areas, especially among those who practiced in non-office settings. A descriptive qualitative study explored the perspectives of residents accepted into the PGY3 programs at Western University on undertaking enhanced training and their career prospects. Participants’ perspectives were shaped by their experiences within the family medicine discipline and training contexts, and by individual resident’s aspirations. Findings from this thesis provide insights for family medicine education, workforce planning, and policy making in the Canadian health system.

Summary for Lay Audience

Family doctors in Canada see patients of all ages throughout their lives in clinics, emergency rooms, nursing homes, hospitals, and patients’ homes, depending on the needs of their patients. Since the 1980s, some family doctors have been choosing to focus their work in specialized areas of medicine – such as sports medicine, emergency medicine, or palliative care. These doctors are often referred to as family physicians with focused practices. The National Physician Survey in Canada in 2014 showed that over one-third of family physicians reported having a focused practice. In addition, while family medicine residency is 2 years in length in Canada, approximately 20 % of residents choose to take an additional year of training, called postgraduate third-year (PGY3) training, in specialized areas every year.

This thesis consists of two studies that aimed to: 1) discover the factors related to focused practice family doctors and the range of focused practice doctors’ work, and 2) understand family medicine residents’ motivations for doing PGY3 training and their future work plans.

Findings from both studies show that multiple factors can influence family doctors’ choices to work in a focused practice, and encourage residents to take additional training. The first study showed that completing PGY3 training could encourage family doctors to focus their work in specialized areas. The type of payment method impacted this choice as well. In the second study, the participants reflected the importance of PGY3 training and specialization to meet the needs of some patients. Participants noted the challenges and changes in family medicine, and shared their experiences during residency, as well as personal factors that made them decide to do PGY3 training and plan their future work. This thesis illustrates that the range of the clinical work of focused practice family doctors is different, but usually concentrated on specialized services, like emergency or sports medicine. Findings from this thesis are important for education in family medicine, and for family medicine workforce planning and policy making in the Canadian health system.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.